World Turns Its Attention to West African Ebola Crisis

Dr. Kent Brantly (R) working at an Ebola treatment clinic in Foya, Liberia, 23 June 2014.

Photograph Courtesy of Samaritan's Purse via EPA

A virus that likely jumped from monkeys to hunters in rural West Africa last spring has now exceeded the ability of three nations there to control it, and threatens to become a global crisis.

On Friday, the head of the World Health Organization delivered a speech to the presidents of Guinea, Liberia, Sierra Leone, and Cote d’Ivoire to outline actions their nations must take to contain the largest-ever ebola outbreak. The WHO announced a $100 million pledge to send more medical staff to West Africa to stem the crisis.

“This outbreak is moving faster than our efforts to control it,” Dr. Margaret Chan WHO Director General said in a Friday speech posted online. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries.”

Chan scheduled an WHO Emergency Committee meeting for next Wednesday and Thursday in Geneva, that “must mark a turning point in the outbreak response.”

WHO officials will decide then whether to declare the outbreak a “public health emergency of international concern,” triggering efforts to reduce the spread. Chan made a point of telling the West African presidents that they are not alone in their fight against ebola; that the world is with them. Next week, when the Ebola crisis will hang over the previously planned U.S.-Africa Leaders Summit in Washington, will start to test that commitment.

No Vaccine, No Treatment

West Africa is in the midst of the biggest outbreak of one of the deadliest viruses ever seen. Bleeding, diarrhea and fever can lead to organ failure and then death.

There is no vaccine and no tailored treatment, other than “supportive care,” to treat symptoms with early care offering the best chance of success, U.S. Centers for Disease Control and Prevention officials said in a news conference this week.

But all previous outbreaks have been controlled—largely by identifying and isolating people with the illness, protecting family members and healthcare workers who treat them, and educating the public about how to avoid infection.

People are only contagious when they are symptomatic. The disease is carried through bodily fluids, largely blood and feces.

CDC Director Tom Frieden tried to calm fears in the United States this week by promising that even if/when someone brings ebola to the United States, it is unlikely to spread far.

American standards of infection control, protective equipment, ability to isolate patients and likelihood of taking a sick person to a hospital rather than caring for them in the community, all suggest that the infection could be quickly contained in the United States, he and other CDC officials said.

Fears are much higher in West Africa, where terrified healthcare workers are sometimes refusing to treat patients bleeding from accidents, because they’re worried the person might have ebola, said John Ly, medical director of Last Mile Health, a charitable organization working in Liberia.

The Liberian healthcare community is small enough, Ly said in an interview, that “everyone knows someone or knows someone who knows someone who has been infected by ebola.”

Cultural Barriers

Isolation facilities, with healthcare workers wearing astronaut-like outfits, are terrifying places where loved ones go and never return. Many people prefer to treat sick family members at home, risking further spread.

The outbreak is unfolding in a region with a long history of government exploitation, civil war and routine terror, journalist and Senior Fellow for Global Health at the Council on Foreign Relations, Laurie Garrett wrote this week for CNN.com.

“Fear, suspicion, poverty, pain and superstition are the norm, the noise that everybody lives with, every minute of their lives,” she wrote, explaining why the public may not follow government efforts to contain the virus. “Ebola is simply a new scream heard above that terrible background din.”

The outbreak has been brewing since March, when health officials first became aware of it. But it turned decidedly more dangerous this week, when it was carried for the first time into the largest city in Africa, the first Americans were sickened, a leading healthcare worker died of the disease, and the US government issued a travel warning for the area.

Among last week’s headlines:

—Patrick Sawyer, a US citizen working for the Liberian government, collapsed after flying to Africa’s most populous city, Lagos, Nigeria. He was immediately isolated and died in a hospital there. He had reportedly caught the virus from his sister in Liberia, mistakenly thinking she had malaria, and was planning to visit his wife and three children in Coon Rapids, Minn., later in the summer, his widow, Decontee, told several news sources.

—The local doctor leading the fight against ebola in Sierra Leone, Sheik Umar Khan, died Tuesday, after getting infected with the virus.

—The Centers for Disease Control and Prevention announced a Level 3 Travel Advisory for the region on Thursday, suggesting that Americans avoid all non-essential travel to the West African nations affected by the virus.

—U.S. President Barack Obama in a news conference Friday said he is taking the oubtreak seriously. The outbreak will likely be discussed next week at the US-African summit in D.C., but leaders of Liberia and Sierra Leone cancelled their trip to Washington, the AP reported, because of the disease.

—The US Peace Corps on Wednesday announced it would evacuate its 340 volunteers from Liberia, Guinea and Sierra Leone.

—Several of the affected countries closed some border crossings and instituted temperature checks at others, according to government statements, trying to limit the spread of the disease across borders.

—The two American healthcare workers who came down with the virus in Liberia, are currently in stable condition, but still at risk, according to the charitable organizations for whom they work. Both American groups, SIM and Samaritan’s Purse, have begun evacuating their other employees, none of whom is sick.

Dr. Kent Brantly working at an Ebola treatment clinic in Foya, Liberia, 23 June 2014.

Photograph Courtesy of Samaritan's Purse via EPA

The fact that Americans and others who were well trained and had adequate protective supplies fell ill raises questions “about whether this is a uniquely/especially contagious strain of the virus,” said Raphael Frankfurter executive director of Wellbody Alliance, a Boston-based organization that operates a clinic in the area.

Both of the American workers, Dr. Kent Brantly, of Fort Worth, and Christian missionary Nancy Writebol, of Charlotte, are being flown back one at a time to the United States this weekend to receive care at Emory Healthcare in Atlanta, a SIM spokesman confirmed late Friday. Dr. Kent Brantly working at an Ebola treatment clinic in Foya, Liberia, 23 June 2014. Photograph Courtesy of Samaritan's Purse via EPA Protective gear is in short supply in many parts of the region, with aid agencies such as AmeriCares and Direct Relief scrambling to provide donations.

Frankfurter, who left the Kono District of Sierra Leone this week, said via email that his clinic was short on chlorine, thermometers, protective goggles, backpack spray system for decontaminating workers and equipment, and vehicles able to transport patients to safe facilities.

“Things have taken a definite turn for the worse this week,” Franfurter said. “Cases have popped up almost everywhere in the country, the death of Dr. Khan has completely shaken the healthcare system, and we’re now having cases in Kono.”

The rest of the world needs to step up its support for West Africa, the WHO’s Chan said, to prevent the disease from becoming even more lethal.

“Ebola outbreaks can be contained. Chains of transmission can be broken. Together, we must do so,” she said.